Provider Demographics
NPI:1770942492
Name:SCHRADER, TRACY (RN)
Entity type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:SCHRADER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 SE 18TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-8215
Mailing Address - Country:US
Mailing Address - Phone:352-622-3360
Mailing Address - Fax:352-629-4512
Practice Address - Street 1:1901 SE 18TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-622-3360
Practice Address - Fax:352-629-4512
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2632592163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse